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Support Remains High for Family Planning at Home, Not Abroad
Americans continue to express “high levels of support” for health insurance coverage of family planning services in the United States, but support for U.S. funding of family planning and abortion services in developing countries is “declining,” said Clifford Grammich, lead author of a new RAND study comparing responses in public opinion surveys conducted in 1998 and 2003.
In both surveys, the study found that more than five in six Americans favored requiring U.S. health insurers to “cover family planning services, just like other doctor’s visits and services, as part of their regular health care coverage.” Slightly less than half of U.S. workers with health insurance plans have coverage for abortion services, according to Grammich.
But public support for U.S. funding of international family planning dropped significantly, from 80 to 69 percent in the time between surveys. Opposition to U.S. government funding for both international family planning and abortion increased significantly. Only 45 percent of Americans support U.S. funding for voluntary abortion services in developing countries, down from 50 percent in 1998. Opposition to U.S. support of abortion services overseas increased from 46 to 52 percent, while those in strong opposition to the policy grew from 33 to 40 percent.
Respondents were asked for their view of a current federal policy requiring nongovernmental organizations to agree, as a condition of receiving U.S. government funds for international family planning programs, that they will neither perform nor promote elective abortion. While support for this policy has remained steady across the two surveys, opinion has become more ideologically polarized. This has not been the case for domestic family planning policies. 
For more information:
Changes in American Opinion About Family Planning (RAND/RP-1148)
Starting Kids Later in Kindergarten Yields Cognitive Benefits But Increases Child Care Costs
Studies have shown that older entrants to kindergarten perform better than younger ones, but do these gains persist over time? And if such gains persist, what types of kids benefit the most?
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“Kids who enter kindergarten at age 6 instead of age 5 — especially kids from disadvantaged families — do significantly better on standardized tests, and the gains persist beyond kindergarten,” said Ashlesha Datar, a RAND associate economist and author of a study examining the benefits and costs of delaying kindergarten entrance age. The study uses a nationally representative sample of kindergartners.
A one-year delay in kindergarten entrance increases math and reading scores significantly. As shown in the figure, which plots the scores on standardized math and reading tests at two points in time — once at the start of kindergarten and again at the end of first grade — such gains persist beyond kindergarten for both poor and nonpoor children.
The figure also shows that the benefits of delaying kindergarten are even greater for children from poor families. While children who are not poor always start off better than poor ones regardless of the age at which they enter kindergarten (shown by the dots), delaying kindergarten entrance from age 5 to age 6 among poor children also increases their subsequent gains in math and reading test scores (shown as the distance between the dots and x’s).
This trend is most notable in looking at math score gains: Poor children entering at age 5 have almost no gain between testing periods, while those entering at age 6 have a much larger gain. There is also greater improvement in reading scores. By contrast, both younger and older entrants from families who are not poor gain the same amount between testing periods.
But delaying kindergarten has a cost, especially for poor families, because families must pay for additional child care costs for children who do not enter school until one year later. The study simulated how potential changes in state policies on kindergarten entrance age would affect child care costs for families.
Eight states with earlier kindergarten entrance ages are currently considering requiring that children start kindergarten at age 6. If that policy were implemented, it would affect more than 90,000 students and lead to $115 million in additional child care costs for families whose children would otherwise enter kindergarten at age 5.
“These findings suggest that policymakers may need to view entrance age policies and child care policies as a package,” Datar said.
For more information:
The Impact of Changes in Kindergarten Entrance Age Policies on Children’s Academic Achievement and the Child Care Needs of Families (RAND/RGSD-177)
Suburban Sprawl Can Be Bad for Your Health, Study Finds
“Suburban sprawl is linked to the prevalence of many chronic health ailments,” said Roland Sturm, a RAND economist and coauthor of a new study that for the first time analyzes suburban sprawl and a broad range of chronic health conditions.
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The study defines suburban sprawl as urbanized areas with separated residential, shopping, and business districts; limited street connections (because, for example, of more cul-de-sacs); and lower population density.
The study used a nationally representative survey that asked adults about a variety of issues related to chronic medical conditions, mental health disorders, and health-related quality of life. The study analyzed information from more than 8,600 people in 38 U.S. metropolitan areas rated by four sprawl measures: (1) residential density, (2) the mix and balance of land uses, (3) the proportion of development in regional cores and subcenters, and (4) street accessibility.
As shown in the figure, the study found that people who live in areas with a high degree of suburban sprawl are more likely to report one or more of 16 chronic health conditions (such as arthritis and diabetes) than people who live in less sprawling areas. The differences reflect the effects of sprawl after accounting for factors — such as age, economic status, race, and the local environment — that could otherwise explain the differences.
The findings suggest that an adult who lives in a more sprawling city such as Atlanta will have a health profile similar to someone who is four years older — but otherwise similar — living in a more compact city such as Seattle. The study also found that the unhealthful consequences of suburban sprawl disproportionately affect the poor and the elderly, who often have fewer resources to make up for the limitations created by the suburban environment.
In contrast, while many researchers have proposed that suburban sprawl results in social isolation that may lead to more mental health problems among suburbanites, the study found no differences in the rates of depression, anxiety, or psychological well-being among people who live in urban versus suburban settings.
“If future research confirms our initial results,” Sturm said, “policies that address the built environment can play a critical role in the prevention of a wide variety of chronic diseases.”
For more information:
“Suburban Sprawl and Physical and Mental Health” (Public Health, October 2004)
Faster Passenger Check-In Can Make Airport Less Vulnerable
There are cost-effective, short-term measures available to improve airport security and reduce the impact of a potential terrorist attack at Los Angeles International Airport. “Reducing lines at the airport could greatly reduce the number of people exposed to a terrorist attack, and the cost of such a reduction is surprisingly low,” said Donald Stevens, a RAND senior analyst.
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The challenge in meeting a terrorist threat is to influence the behavior of an unpredictable enemy — to make terrorists see the airport as an undesirable target that is not worth their effort. In this light, researchers examined a number of plausible attack scenarios (as shown in the figure) and concluded that various kinds of potential bomb attacks present the greatest and most plausible risks. The major threats include bombs placed on airplanes — either as cargo or by an insider who plants a bomb without boarding — and bombs placed in vehicles or in luggage around the airport.
Given the scenarios, the study considered some low- and highercost options to make the airport less vulnerable in the near term. The most cost-effective short-term option is adding employees to check luggage, resulting in faster passenger check-in and faster Transportation Security Administration screening.
This option would require around $1 million in capital costs and $4 million in increased annual operating expenses. It would significantly reduce the size of crowds in public spaces, thus making the airport a less appealing terrorist target and reducing potential casualties should terrorists strike. In fact, increasing the number of check-in and screening workers by just 5 percent could reduce fatalities by 80 percent if terrorists detonated a handheld luggage bomb in a check-in area.
In addition to reducing the density of crowds in the terminals, the researchers concluded that it would be cost-effective to add a permanent vehicle checkpoint program to identify vehicles that might be carrying large bombs. A vehicle screening system might eventually include scales embedded in the roadway to quickly weigh all vehicles entering the airport, allowing officials to identify those that might be weighed down with explosives.
Beyond these two security measures that address vulnerabilities at a relatively low cost, four other measures should be considered for improving airport security. Two would address major vulnerabilities but are relatively expensive: screening all cargo transported in passenger planes and improving the employee selection and clearance procedures. The other two measures — improving perimeter fencing and improving the airport’s rapid-response capability — address less serious vulnerabilities but could be implemented at low cost.
For more information:
Near-Term Options for Improving Security at Los Angeles International Airport (RAND/DB-468-1-LAWA)
Compensation for 9/11 Terror Attacks Tops $38 Billion
In the wake of the 9/11 terrorist attacks, the compensation system provided massive payments to businesses and individuals in New York City. “Losses from the 9/11 attacks induced the largest insurance payments for a single-loss event in U.S. history, unprecedented charitable distributions, and a massive government response,” including the creation of the September 11th Victim Compensation Fund of 2001, noted Lloyd Dixon, a RAND senior economist and lead author of a report that examined the entire 9/11 compensation system.
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The study quantified more than $38 billion in benefits across the three compensation mechanisms involved, as shown in the bottom row of the table. Liability caps for the airlines and other potential defendants have limited the role of the tort (or liability) system, at least so far.
The study examined how the benefits were distributed among victim groups. Sixty-one percent of the total quantified benefits (more than $23 billion) went to businesses in New York City, and nearly threequarters of the benefits received by businesses came from the insurance industry ($17 billion).
Nearly $8.7 billion (23 percent of the total benefits) went to civilians killed or seriously injured. Nearly 70 percent of this sum came from the government. The remaining benefits of roughly $6 billion were spread among the other victim groups.
The insurance industry received praise from key stakeholders interviewed for the study for its quick response and generous inter- pretation of policies. But some stakeholders noted problems with business-interruption coverage.
The government response varied among agencies. The federal Victim Compensation Fund and the unemployment, Medicare, and Social Security programs were perceived as having responded well. In contrast, the Federal Emergency Management Agency was criticized for being too slow and inflexible, for not coordinating efforts well with charities, and for not addressing long-term emotional injuries from the attacks.
Charities were praised for responding quickly, distributing money quickly, and meeting unmet needs. But charities were criticized for focusing too much on Lower Manhattan, for not coordinating among themselves and government agencies, and for going beyond their traditional roles.
The response to 9/11 was unique and did not establish a blueprint or set of enduring institutions for compensating victims of future large-scale terrorist attacks. Among the key issues that need to be addressed in the future are coordination among different payment sources; the appropriate and respective roles of the government, the insurance industry, charities, and the tort system; and the national security ramifications of different compensation approaches.
For more information:
Compensation for Losses from the 9/11 Attacks (RAND/MG-264-ICJ)
Law Enforcement Agencies Expecting Terrorist Attacks Are Generally Better Prepared
After the 9/11 terrorist attacks, law enforcement agencies bolstered their preparedness efforts, but there is substantial variation in approach and needs among local agencies in small and large metropolitan counties, according to a new report by the RAND Corporation.
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The report, based on a nationwide survey of 208 state and local law enforcement agencies that was conducted just prior to the formation of the U.S. Department of Homeland Security, “provides the department with an important benchmark to assess improvements in preparedness and to better target federal funding to the law enforcement community,” said Lois Davis, senior policy researcher and the study’s lead author.
In response to 9/11, state and local law enforcement agencies (particularly those in large counties) undertook a number of steps to improve preparedness for terrorist attacks. Many agencies increased the number of personnel conducting emergency response planning; updated response plans and mutual aid agreements for chemical, biological, and radiological attacks; and increased departmental spending.
But the approach to preparedness has varied by the size of the county. Local law enforcement agencies in large counties have been more engaged in planning and training activities than those in smaller counties.
The flow chart illustrates several findings. Law enforcement agencies that perceive the risk of future terrorist attacks to be higher for their jurisdictions are generally more engaged in terrorism preparedness activities. But perception of risk does not correspond with size of jurisdiction. Even agencies in smaller counties, if they assess the risk to be higher for their jurisdictions, usually improve their levels of preparedness. Perceived risk — not jurisdiction size — is also the better predictor of receipt of federal funding for preparedness activities.
While rural areas are often seen as unlikely terrorism targets, terrorists could strike there because “much of our critical infrastructure and some potential high-value targets, such as nuclear power plants, are located in less populated areas,” Davis said. “Moreover, while preparedness funding has been directed more to populous counties, this study underscores the need for federal and state grant distribution mechanisms to incorporate level of risk into their allocation formulas.”
The study also identified some key support needs to improve response and assessment capabilities, which also varied by county size. “By revealing what local and state law enforcement officials say they need to respond to terrorist attacks more effectively, our study can help state and federal policymakers determine what assistance to provide,” said Davis.
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